Provider Demographics
NPI:1255767497
Name:BRENNAN, SHANNON R (LCMHC, LADC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LCMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7406 CHAPEL HILL ROAD
Mailing Address - Street 2:STE J
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5039
Mailing Address - Country:US
Mailing Address - Phone:984-310-9811
Mailing Address - Fax:
Practice Address - Street 1:7406 CHAPEL HILL ROAD
Practice Address - Street 2:STE J
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5039
Practice Address - Country:US
Practice Address - Phone:984-310-9811
Practice Address - Fax:919-573-0438
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19532101YM0800X
VT068.0081022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health